Spanish Experience in Liver Transplantation for Hilar and Peripheral Cholangiocarcinoma

Robles, R; Figueras, Joan; Turrión, Víctor Sánchez; Margarit, C; Moya, Àngel; Varó, Evaristo; Calleja, J; Valdivieso, A.; Valdecasas, Juan Carlos García; López, Pedro Benito; Gómez, Manuel; Vicente, Emilio; Loinaz, Carmelo; Santoyo-Santoyo, Julio; Fleitas, Manuel Gómez; Bernardos, Á.; Lladó, Laura; Ramı́rez, Pablo; Bueno, F.S; Jaurrieta, Eduardo; Parrilla, Pascual

doi:10.1097/01.sla.0000108702.45715.81

Cited by 275 publications

(166 citation statements)

References 28 publications

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“…The Cincinnati Transplant Tumor Registry reported 28% 5-year survival, with a tumor recurrence rate of 51% [88] . The Spanish liver transplant centres provided similar results, with 30% 5-year survival rate and 53% tumor recurrence rate, in 36 patients with unresectable, non-disseminated HCC [96] . As a consequence of such initial results and the limited availability of organs, HCC was perceived as a relative contraindication to OLT.…”

Section: Hilar Cholangiocarcinoma No Of Patients Prognostic Factors supporting

confidence: 61%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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vein embolization and staging laparoscopy should be considered in selected patients. Additional evidence is needed to fully define the role of orthotopic liver transplant. Portal and lymph node involvement worsen the prognosis and long-term survival, and surgery is the only option that can lengthen it. Improvements in adjuvant therapy are essential for improving long-term outcome. Furthermore, the lack of effective chemotherapy drugs and radiotherapy approaches leads us to can consider R1 resection as an option, because operated patients have a longer survival rate than those who not undergo surgery. INTRODUCTIONCarcinomas arising from the confluence of the hepatic ducts were first described by Altemeier et al [1] . Klatskin [2] Alejandro Serrablo, Luis Tejedor Outcome of surgical resection in Klatskin tumors TOPIC HIGHLIGHT AbstractCholangiocarcinomas are the second most frequent primary hepatic malignancy, and make up from 5% to 30% of malignant hepatic tumours. Hilar cholangiocarcinoma (HCC) is the most common type, and accounts for approximately 60% to 67% of all cholangiocarcinoma cases. There is not a staging system that permits us to compare all series and extract some conclusions to increase the long-survival rate in this dismal disease. Neither the extension of resection, according to the sort of HCC, is a closed topic. Some authors defend limited resection (mesohepatectomy with S1, S1 plus S4b-S5, local excision for papillary tumours, etc .) while others insist in the compulsoriness of an extended hepatic resection with portal vein bifurcation removed to reach cure. As there is not an ideal adjuvant therapy, R1 resection can be justified to prolong the survival rate. Morbidity and mortality rates changed along the last decade, but variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Conclusion: Surgical resection continues to be the main treatment of HCC. Negative resection margins achieved with major hepatic resections are associated with improved outcome. Preresectional management with biliary drainage, portal José M Ramia, MD, PhD, Series Editor

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Section: Hilar Cholangiocarcinoma No Of Patients Prognostic Factors supporting

confidence: 61%

Outcome of surgical resection in Klatskin tumors

Serrablo

Tejedor²

2013

WJGO

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“…Since PSC patients are a large group in many liver transplant programs not surprisingly a relatively significant number of patients have concomitant intrahepatic CCA and PSC. There have been recent reports of an approximate survival rate of 30% after 5 years in this population (7,19). In a recent series of patients from the Nordic countries we had a 5-year survival of 38% for those with a TNM-stage ≤ 2 (20).…”

Section: Treatmentmentioning

confidence: 88%

Cholangiocarcinoma — Current Treatment Options

Friman

2011

Scand J Surg

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The treatment for cholangiocarcinoma (CCA) remains a challenge because of the aggressive nature of the disease and the absence of effective treatments besides surgical resection (HR) and liver transplantation (LT). In intrahepatic CCA, HR remains the treatment of choice whereas with concomitant liver disease such as cirrhosis or primary sclerosing cholangitis (PSC), LT is the only option. Hilar CCA or Klatskin tumours have in recent decades been managed with a more aggressive surgical approach to achieve R0 resection. This approach usually involves preoperative portal embolisation, followed by liver resection — Sometimes extensive and even with portal vein resection. The recent protocols that combine preoperative neoadjuvant chemoirridation and LT show promising results that need to be confirmed. The development of diagnostic modalities (tumour markers, cytology and radiology) are of the utmost importance to identify these patients at an early stage to preserve radical surgery possible. Cholangiocarcinoma (CCA) is a malignant disease of the epithelial cells in the intra- and extrahepatic bile ducts. While still a rare malignant disease, CCA is the second most common primary malignancy of the liver. The incidence is increasing; especially the incidence of intrahepatic CCA (1). The treatment of CCA is challenging as it is usually difficult to diagnose when radical surgical treatment, resection (HR) or liver transplantation (LT) is possible. The lack of effective medical treatment makes a radical surgical resection or hepatectomy the only therapeutic option. Most of the CCAs are unresectable at presentation and the prognosis for these patients is dismal.

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“…Patients requiring a total hepatectomy to achieve a negative margin and those with underlying liver failure precluding hepatic resection are possible candidates for OLT, but early experience with OLT for hilar cholangiocarcinoma was disappointing with early recurrence rates of more than 50% and a 5-year survival rate of 10% to 20% [161][162][163][164] . Recently, in highly selected patients undergoing neoadjuvant protocols, improved survivals were reported with a 5-year survival rate of 30% to 45% [165][166][167] . More recently, the socalled "Mayo protocol" was reported with the intent of treating a highly selected group of patients with cholangiocarcinoma with a strict regimen of preoperative staging and neoadjuvant chemoradiation followed by OLT [168][169][170] .…”

Section: Liver Transplantation For Hilar Cholangiocarcinomamentioning

confidence: 99%

Surgical strategy for bile duct cancer: Advances and current limitations

Akamatsu

Sugawara²,

Hashimoto³

2011

WJCO

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The aim of this review is to describe recent advances and topics in the surgical management of bile duct cancer. Radical resection with a microscopically negative margin (R0) is the only way to cure cholangiocarcinoma and is associated with marked survival advantages compared to margin-positive resections. Complete resection of the tumor is the surgeon's ultimate aim, and several advances in the surgical treatment for bile duct cancer have been made within the last two decades. Multidetector row computed tomography has emerged as an indispensable diagnostic modality for the precise preoperative evaluation of bile duct cancer, in terms of both longitudinal and vertical tumor invasion. Many meticulous operative procedures have been established, especially extended hepatectomy for hilar cholangiocarcinoma, to achieve a negative resection margin, which is the only prognostic factor under the control of the surgeon. A complete caudate lobectomy and resection of the inferior part of Couinaud's segment Ⅳ coupled with right or left hemihepatectomy has become the standard surgical procedure for hilar cholangiocarcinoma, and pyloruspreserving pancreaticoduodenectomy is the first choice for distal bile duct cancer. Limited resection for middle bile duct cancer is indicated for only strictly selected cases. Preoperative treatments including biliary drainage and portal vein embolization are also indicated for only selected patients, especially jaundiced patients anticipating major hepatectomy. Liver transplantation seems ideal for complete resection of bile duct cancer, but the high recurrence rate and decreased patient survival after liver transplant preclude it from being considered standard treatment. Adjuvant chemotherapy and radiotherapy have a potentially crucial role in prolonging survival and controlling local recurrence, but no definite regimen has been established to date. Further evidence is needed to fully define the role of liver transplantation and adjuvant chemo-radiotherapy.

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Spanish Experience in Liver Transplantation for Hilar and Peripheral Cholangiocarcinoma

Abstract: OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.

Cited by 275 publications

References 28 publications

Outcome of surgical resection in Klatskin tumors

Outcome of surgical resection in Klatskin tumors

Cholangiocarcinoma — Current Treatment Options

Surgical strategy for bile duct cancer: Advances and current limitations

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